HomeMy WebLinkAbout21-1433 a
City of Zephyrhills PERMIT NUMBER
r' 5335 Eighth Street
Zephyrhills, FL 33542 BGR-001433-2021
Phone: (813)780-0020
Fax: (813)780-0021 Issue Date: 02/26/2021
Permit Type: Building General (Residential)
Property Number Street Address
1126 210010 09300 0111 38029 9Th Avenue
Owner Information Permit Information Contractor Information
Name: JASON MCCAHAN Permit Type:Building General(Residential) Contractor: PAUL D. SCHAPER
Class of Work:Reroof ROOFING INC
Address: 38029 9Th Ave Total Valuation:$8,452.00
ZEPHYRHILLS,FL 33542 Total Fees:$149.76
Phone: (727)421-3061 Amount Paid:$149.76
Date Paid:2/26/2021 8:43:13A
Project Description
REROOF SHINGLE W/FLAT TPO ROOF AREA ON BACK
Application Fees
BP REVISION FEE $67.50 Building Permit Fee $82.26
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each subsequent reinspection.
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner:Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications add fee Must Accompany Application.All work shall be performed in
accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTRACTOR SIGNATURE PE IT OFFICE
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax 813-780-0021
Building Department
Date Received M q2Q
Phone Contact for Permitting
Owner's Name Aac� Owner Phone Number _7,T7 `42-1-3067,
Owners Addressl .3 t 02_q q44) Atx Owner Phone Number
Fee Simple Titleholder'Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 53so2_q A,.w_ LOT#
SUBDIVISION PARCEL]D#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTRR . ADD/ALT SIGN DEMOLISH
e INSTALL REPAIR
PROPOSED USE Q SFR 0 COMM OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME0 STEE?1 =
DESCRIPTION OF WORK 101 A TE
BUILDING SIZE SQ FOOTAGE= HEI!�
A I
BUILDING 1$ • 00 VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE r Q PROGRESS ENERGY W.R.E.C.
=PLUMBING 1$
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING F__1 SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES' N
..................
HHHHHHHHHHHHH 11 low*
.,BUILDER COMPANY
SIGNATURE -,REGISTERED FEECURR�" L
Address C license# i ti—W 05 513 ELECTRICIAN COMPANY
SIGNATURt REGISTERED Y./ .,FEE CURREN L_Y_LN J
Address License
PLUMBER COMPANY
SIGNATURE REGISTERED L_Y/`N`J+ FEE.CYRREN
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y:/'N J_ IFEE CURREN'
Address -License# F_
OTHER compANy
SIGNATURE REGISTERED I Y+/_N_-1 -FEE CURREt, L Y,I N.-J
Address License,#
RESIDENTIAL Attach+(2):Plot Plans;(2),sets of-BuIldIngPI,Plans;(1);set of.,Energy Forms;R-O-W Permit-forpew.construction,
Minimum ten(10)�vorkilqg",d�iys aftdr*i;ubmittaI date:,Req"uirdd-onsite'ConstrucHon Plans,Storrnwatdr Plafivwl.Slit Fence installed,
Sanitary'Facilifi_eIi&1-dUmpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life-Safety,Page;_(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(16)working days-after submittal date: Required.onsite,Construction Plans,Stormwater Plans W1 Silt Fence installed,
Sanitary Facilities&I dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERTY.SURVEY,required for all NEW construction.
`Directions: '
Fill out application completely.
Owner&Contractorsign,,pack of application,.notarized
If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
Agent(for the contractor)or Power of Attorney(for the owner)would be someone With notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING .(copyof contractrrequired)
Reroofs If shingles Sewers Service-Upgrades A/C Fences(Plot/Survey/Footage)
Drivewayi-Not over Counter if on public roadways..needs ROW
NOTICE'OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions..
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If tiie ,owner has'hired a contractor or
contractors to undertake work, they may be required.to be licensed.in accordance with state,and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor maybe cited for a misdemeanor violation
understate law. If the owner or intended-contractor are uncertain as to what lic m for the. ,.
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is.advised to have the-contractors) sign
portions of the "contractor Block" of this application.for which they will be responsible.. If you,.as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE.RECOVERY FEES: The undersigned understands
that Transportationlmpact Fees and Recourse Recovery Fees,may-apply to,the-construction of new buildings, change of
use in existing buildings;or expansion of existing buildings,,as specified in Pasco County Ordinance number 89-07 and
90-07, as amended.. The undersigned-also understands, that sucli'fees; as may-be due, will be.identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate.of occupancy" or final power release. Iftheproj.ect does.not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. 'furthermore, if Pasco CountyWater/Sewer Impact
fees are..due,.they-multi-'a paid.priorto permit issuance in..accordanceVith applicable Pasco County ordinances.
CONSTRUCTION:-LIEN'LAW('Chapter 713;Florida Statutes,as amended): If valuation of work is$2,500,00 or more, I
certify that I-j ,the,applicant, have-been -provided with-a, copy of.the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida.Department of Agriculture and Consumer Affairs. If the applicant.is someone-
other than the"owl er";"'I`certify that I have obtained a copy of the above.-described document and promise in good faith to
deliver it to the"own.ee,,'.prior to commencement.
CONTRACTOR'S/OWNEW AFFIDAVIT I .certify.that.all,the::infor..mation:in,this.:application:is accurate,and that all work
will be done in compliance With all applicable laws regulating construction, zoning and�land development.' Application-is
hereby made to obtain a permit to do work and installation as`-indicated: I certify that no work.or installation has
commenced prior:to.lssuance'of a permit and that.all work will,.be performed to..meet'.standards of all laws regulating
construction;°:`County and City codes; zoning regulations, and.land'development regulations in the jurisdiction. I also
certify thatT.understand`that the regulations of other government agencies may apply.to the intended work, and that it is
my responsibility'to.:identify what actions I must take to be.in compliance.•Such agencies include but are not limited to:
-Department of"Environmental Protection-Cypress Bayheads, 'Wetland Areas,and.Environmentally Sensitive
Lands;WaterM/astewater Treatment.
Southwest. Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altelring
Watercourses.
Army'Corps of Engineers-Seawalls;Docks, NavigableImIterways:
- Department of Health & Rehabilitative Services/.Environmental 'Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection.Agency-Asbestos abatdMent:4
Federal Aviation Authority-Runways..
I-understand.that.tle following.restrictions apply to the use.offill ^'
- . Use of fill"is not allowed in.Flood'Zone'V"•unless-:eXpressly..permitted.. .
If.the'fill material'is to be used in Flood Zone:j,"'A';"it_`is"uiderstood'that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting;,which,:is,prepared by a professional engineer,
licensed by the State of Florida.
If he fill,material .is to:be used'in-Flood Zone "A"",in rconnection with a permitted building'using stem:wall
construction.'I,certifythat fill will be-used only to fill Atl'e acea within the-,stem:wall.
If fill.material'is to bey used in any area, I certify.th;*.-use.of such fill will not adversely affect adjacent -
properties,-.-.,:If use.of fill is-found.to,adversely aff6dt;:::adjacenti:pro
pert ies;the owner may,be cited for violating
the conditions of-the building permit'issued-under:;thewattached,permit.application, for lots less than one fl.).
acre w1 icKwe.elevated:byfill, an.engineered°drainageplan is required.
If I am the=AGI=NT FOR-'THE OWNER, I promise in goodfaiff to`,inforlmtlie owner�of..the perm itting-conditions set forth in
this affidavit:priorto,commencing construction. I understand.,that a,separate permit may be required for electrical work,.
plumbing,!e'signs, wells'..pools, air conditioning, gas; or--other instaliations:,not iodbifically included in the,application. A
permit issued shall be construed to be a license to proceed with the,work and not as authority to violate, cancel,- alter,;or
set aside::any..provisions:of the`technical codes., r—sFiall'`issuance; a permit-prevent the Building Official from thereafter,,,,:
requiring::a correction of errors in plans, construction or violations•of-any-codes:°-Every permit issued shall become invalid
unless the'work•authorized by.such permit is commenced within Rsix,;months_of permit issuance, or if work authorized,•by
the permit's-suspended or abandoned for a period of six:.(6)months-after the'tirri6 the work is commenced. An extension
may be-se
quested, in'writing, from the Building Official for a iperiod,;not to exceed ninety (90) days and will demonstrate,!-` `<
justifiable cause for the extension. If work.ceases forninety(90)consecutive days,the job.is considered abandoned. " ='
WARNING TO OWNER: YOUR::FAILURE'TO RECORD A NOTICE-OF-.COMMENCEMENT.MAY.RESULT IN YOUR`='
PAYING.-WICE`FOR IMPROVEMENTS TO:YOUR`PROPERTY:'''IF'YOU-INTEND TO:OBTAIN FINANCING;CONSULT` "--`"
— WITH-YOURsLEND.ER OR AN.&T---ORNErBEFORS,,RECORDING.°1FOUR=BIOTIC F COMMENCEMENT. - -- -
FLORIDA JURAT(F.S'.11 :03
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or a ed)before me this Subscribed.and swom to(or affirmed) fore me this
I-26-zi by �.�du 3nInca,�X 1- A-Z. by
Who Is/are personally knownfo me or4asft ve amd Who Is/are personally known t me or
as Identification. as identification.
Notary Public Notary.Public
Commission No. Commission No.
Name of t. n e o s a a Name.o of ,�rped m or s�r��e
Notary Public State of Florida , �cr, N��ary ublic a of lorida
Alicia Henveh-Cannon ;F Alicia Herweh-Cannon r>>'
9, < My Commission GG 218378 < My Commission GG 218378
�j00 Expires 06/16/2022 ati Expires 05/16/2022 't±
R.
41
t"{.;• -" 't -,��_t";•��Svi �9 i.l .: .._}� �'3 �'`.-. _-i i 71 r-'-- _z
Wit:-.� ...L�:1 i{'i'�C� it_fILL'Il',�i°a ".'; .n`_'_f t•i3`,i'-_+ •_ 'a`•3l is--'..-5'�'E' _:1'-_:-iiv''u f' ��t --EC=�'_'�!-a
``f.T:._ I-`. p;er o.a.s 3 'mot5'-" _ CK'V
?zxa5a y�J i.C: f' r<a y j F aw : n
`)i,..i.�.I-„-.�• '<-3 L / f` / / 4 r�-•_
w �
'-�-� � _ r`f �.it-_''� �� b-� l [ P_f. �5�'��^ ���..e`�C,/'" l r:: f�,-* _- �.'+�', ..r¢��_t�t;•j�
},ti " ?:L°° g= 'a_'-w�� =tea i1:'__=� 2�E?:?•f'cs:•5 '3�]
69v A:
:� }a:t r�: t�i;3 :r v-�L ;-•x�i__ s �,s-_ :� - e..:�,:=>: -
_r: a 3s•_ - 1.;4. ti:,. S.�_- _ _� z i _ `9'y. �L'.. - y =5 t Y 2 2Y.v
>,�).ii_ _ i isv�• l.� dZ�. ))�'- _ Tom-_sou>�_r.<_ s.,�
�� £7` y F - 1.3. -!-:- ss •i -¢ 'a -z 17 �F:�,:<r.,a-- �r-�r';
�'`_`'r`'__ -z' �."s ce_�5. '_C.S�i. 3i'� -=S=%i s_=�.i`��,j °14�l ��i:._ k6�'.t4:c :�'�{.. I-S� _ifs .._5`-�33,i F- - ��f•.;9$;_. °�,3_z:
,., Y"v' '„'a'i'`-{L z b'd`� ��+`od C.'im fi �S 'r-- `z.:,1 �_'z'"..'''°-�• Cv lt' c``s5 1�' �.Cs Sa si -�} �2_,�'i Li} S_
tF7F'iE'¢'f. m&'d up i za cent 0-in, c_r'ICq t {�:.
s.
T+r�r ,s:+ s "` C�_ `= ='=_,! ;.ti'-- s far _a
1. '. - �; �^'.. 1�s —_—•_ f-'t.a;=x�c.� -` 1�---.-.aF ;� �;::.��••e __-eg•�'k`z :3 r<_o=_;'c, i��;i:��?;'_T`)r.,=
zzA
ft.�.'i� C l- � __ _�d i_ 3 -t•�__ �_ r_SL<� ih•_J+__ _-_ __1! _ - _._ 4-F__ __.
_. -1E al _c ve31.F.e', :,i :ziisaT 1.S' .-Eil .R41• 1v -t_'-.:3 € l of
..3.._ 1�.h r. _ i.R.: a.:: �'•..' .
3
r@ nI ILA- Y�'?=' 0'-@ :3 1_w
1�m let,
� i "•``'i.:ii CF efi.=:.K..:t i �'�' "#: :T .€:F. 7 w d�it"-1':?`.='ci 7•+:. '
_u- Tf- _3e 1• _ S :.a.-4 F.i.�-_e�c:�8 'F".s>i2: '{.� -tee.;-'r:'E-'.a�'C_ __ -'avT
��Au'.ea ���- �''.. �J 9 lam'••-°• °i.a c7.'. ,sS;:.r .'�°-F.:_r.;:.:. .�'�;r �.:_ iit. ..��u.:_. �� .
z=-.- d_ '•,v- *_. - ' �s; �r - -"Fri.
_. _-.. _i'-f-� _a"._Y�----- :-----` ''91?� -_:•- -z LLL: _z `s�=Fz - =� _€gP'-?aa_�_ `- _° :f_=?Y._
is °„'xl Lit .i 'c�k�' r :_.F ,r� L`.r� :+=a.s_a�. t? `i=t= i n.-en`s.
;Z I
.25
HA i `ateC)il- (f N H Aik 1U fff R. Ia1
gi yg,..,v zin.-
_ou
Tf77 'A AR 7 l vM H 1 ZaI
;j, E4nT• M Wjlv-
"I N C1.1- C
-In
sz x, ni
3-
R3,
N--Z
HMVI '13F
ED
----------------------- ----------
--sf RAICIf W
F3
ny -d
.3risr, YTTM XJDIT-JgJMM-i 'pq�� s nu ax; r�p- 7 n
ugd.i
1 2' �0-F 16-L. T d J 1XII qll-) 16 2
jB �Rv
Cts� am. u
Hal:
En ayi1,iK--, kV, p
D. 143r H.-P 7-U� .TT. UM
F-1;3,i Tr 'T uni ja
ZY,
z 7
uk
INSTR#2021018154 OR BK 1 0267 PG 2444 Page 1 of 1
01/28/2021 03:02 PM Rcpt:2254376 Rec:10.00 DS:0.00 IT:0.00
Nikki Alva varez-5owles Esq Pasco County Clerk&LComntroller
NOTICE OF COMMENCEMENT
State of FLORIDA County of Pasco
Property Identification No:
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in
accordance with Section 713 of the Florida State Statutes,the following information is provided in this Notice of
Commencement:
1.Legal Description: C,, eyG' Z-cp � g p� t ?C� Sq C-a5 ' 'i0 YVA-
Long t1 tz, %5 , l%k block, ct3 or $IL1Z P% 1%01
Street Address: 39602.Cl 941 A*L 7-cp6-L(h` i,5 FL, 333Q2_
2. General Description of Improvement: 5t-.e- «-cvojP aid -- o
3.Owner Information or Lessee information if the Lessee contracted for the improvement
a)Name and address: s.cc-j a-k
3 s o ZA gam. +tee.
FC $asuz-3q 53
b)Name and address of fee simple titleholder(if other than owner):N/A
c)Interest in property:Owner
4.Contractor: Paul Schaper,8949 Gall Blvd.,Zephyrhills,FL 33541—Ph:(813)782-0920,Fax:(813)715-4875
5. Surety: N/A
6. Lender: Name/Address: N/A
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may
be served as provided by Section 713.13(1)(a)(7),Florida Statures:
a) Name and address: N/A
b) Telephone No.: Fax No.
(Opt)
8. In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(b),Florida Statutes:
Paul Schaper,8949 Gall Blvd,Zephyrhills,FL 33541—Ph:(813)782-0920—Fax:(813)715-4875
9. Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a
different date is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA
STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU
INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA
COUNTY OF PASCO
Signature of wner or Owner's Au onzed Officer/Director/Partner/Manager
Print Name
The foregoing instrument was acknowledged before me this 61-7 day,of ,202 (,by
,r3sctlk HdG2k rn as 0(_1A_!1 C (type of authority,e.g.o icer, t e,
attorney in fact)for (name of party on behalf f who t
was executed).
Personally Known OR Produced I&ntification i tore
Type of Identification Produced
Notary Public State of Florida
;P �; Alicia Herweh-Cannon
My Commission GG 218378
aR Expires 05/16/2022
i
i
i
I
State Of Florida,County te unty Of Pas
This is to certify that the foregoing is a
true and correct copy of the document '.
on file or of public record in this office. + °
v rus2
Witnes y hand d official seal this � �z:;>•v��
day of; 2
Nikki Alvarez So s,Esq.,C &Comptroller
Pasco�OytloridgyDeputy Clerk
FORMA 09PAATM5NT OP
Business & Professional Regulation
BCIS Home I Log In I User Registration Hot Topics Submit Surcharge Stats&Facts Publications Contact Us SCIS Site Map Unks Search
Product Approval
USER:Public User
Product Approval Menu>Product or ADollcation Search>Application List>Application Detail
FL* FL12772-R7
Application Type Revision
Code Version 2020
Application Status Approved
Comments
Archived 0
Product Manufacturer Mule-Hide Products Co.,Inc. ALL WORK
Address/Phone/Email 1195 Prince Hall Dr CODES
Ep EI OHALL
AL*'p
C
oC,
Beloit,WI 53511-5481 1VR1DA
(608)365-3111 Ext 809 AM ��AL
eLec "UWO
N6a
cL0 elindar@nemoetc.com ORDIIVANCTy OFR/FPHyDjj
Authorized Signature Timothy McFarland �8 lindar@nemoetc.com
Technical Representative Tim McFarland
Address/Phone/Email 1195 Prince Hall Dr
Suite A
Beloit,WI,535115481
(608)365-3111
tim.mcfarlandlPmulehid"R aV/;z VI/DA
cl*r �
Quality Assurance Representative PIA Y OF ?181?1
Address/Phone/Email 'V EX4 "H
I
FR
Category Roofing
Subcategory Single Ply Roof Systems
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida
Professional Engineer
El Evaluation Report-Hardcopy Received
Florida Engineer or Architect Name who developed Robert Nieminen
the Evaluation Report
Florida License PE-59166
Quality Assurance Entity UL LLC
Quality Assurance Contract Expiration Date 12/14/2021
Validated By John W.Knezevich,PE
El Validation Checklist-Hardcopy Received
Certificate of Independence FL12772 R7 COI 2020 01 _C01 NIEMINEN.pd
Referenced Standard and Year(of Standard) Standard y_qff
ASTM D6878 2013
ASTM G155 2013
FM 4470 2016
FM 4474 2011
UL 1897 2012
Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Method Method 1 Option D
I
Date Submitted 10/05/2020
Date Validated 10/08/2020
Date Pending FBC Approval 10/14/2020
Date Approved 12/15/2020
Summary of Products
FL# Model,Number or Name Description
12772.1 Mule-Hide TPO-c Single Ply Roof Single PIYd thermoplastic polyolefin CTPO)roofs stems
Systems
Limits of Use Installation Instructions
Approved for use in HVHZ:No FL12772 R7 II 2020 10 05 FINAL Al ER FL12772-R7 pdf
Approved for use outside HVHZ:Yes Verified By:Robert Nieminen PE-59166
Impact Resistant:N/A Created by Independent Third Party:Yes
Design Pressure:+N/A/-722.5 Evaluation Reports
Other:1.)The design pressure noted in this application FL12772 R7 AE 2020 10 05 FINAL ER FL12772-117 Ddf
pertains to one assembly.Refer to ER Appendix for all Created by Independent Third Party:Yes
assemblies and max,design pressures.2.)Refer to ER
Section 5 for Limitations.3.)Refer to FL28296 for HVHZ
jurisdictions.
Back Next
Contact Us::2_601 Blair Stone Road.Tallahassee FL 32399 Phone:850-487-1824
The State of Florida is an AA/EEO employer.Copyright 2007-2013 State of Florida.::Privacy Statement::Accessibility Statement::Refund Statement
Under Florida law,email addresses are public records.If you do not want your e-mail address released In response to a public-records request,do not send electronic
mail to this entity.Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.-Pursuant to Section 455.275(1),
Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address If they have one.The emails
provided may be used for official communication with the licensee.However email addresses are public record.If you do not wish to supply a personal address,please
provide the Department with an email address which can be made available to the public.To determine if you are a licensee under Chapter 455,F.S.,please click here_.
Product Approval Accepts:
®IM FmiW WIN
Credit Card
af@,:.,::::..
c ►
D
City of Zephyrhills
5335 8th St
Zephyrhills FL 33542
(813)780-0020
:ROOFING INSPECTION AFFIDAVIT
Permit No.: 6GR-oc VA&3-anal
I, licensed under Chapter 468, Florida Statutes as a(n):
Contractor �Ongineer_Architect_Building Inspector_
License No. CC'l'- CSl3 y
On or about 10 did personally inspect the:
Check: Roof Deck Nailing Dry in Flashing and Drip edge
Check which was used: 30#felt_Peel and Stick Other(List)
At the following
address: O Q
Based upon that examination, I have determined the installation was done according to the Hurricane
Mitigation Retrof+Manu (Basedn Section 553.844, Florida Statutes).
Signature:
STATE OF FLORIDA
COUNTY OF PASCO
Sworn to ands scribed a ore is ay �� kd 202(
BY:
Notary Public State of Florida